Providing top notch care to pregnant women with COVID-19

Courtesy of Emma Saxton

Over the last year, I have learned so much about the novel COVID-19 virus. Undoubtedly, this health pandemic has impacted so much of what we do here at Texas Children’s. As a physician trained in both maternal fetal medicine and critical care at Texas Children’s Pavilion for Women®, I provide care to patients with high-risk pregnancies, including those who have become ill due to COVID-19.

According to the Centers for Disease Control and Prevention (CDC), pregnant women have a greater chance of developing severe illness from COVID-19 compared to non-pregnant women. Additionally, pregnant women with COVID-19 may be more likely to have adverse outcomes, such as preterm birth as a complication of the severe illness. When a patient comes to us for care, our team evaluates each patient on a case-by-case basis to determine the best treatment approach that will produce the best outcomes for mother and baby.

Once a positive COVID-19 diagnosis is confirmed, our team evaluates the condition of both mother and unborn child. From a multidisciplinary perspective, there are many factors to consider in their care: How far along is mom in her pregnancy? How severe are her COVID-19 symptoms? Can pregnancy worsen her condition? What impact will COVID-19 treatments have on the mother and her unborn baby? When is the right time to deliver the baby given these health concerns? Will early delivery improve mom’s condition?

When Emma Saxton, a 29-week pregnant mother, was lifeflighted from a hospital in Lufkin, TX, to the Pavilion for Women, she was in severe respiratory distress. She had been diagnosed with COVID-19 pneumonia with worsening acute hypoxemic respiratory failure and required mechanical ventilation. Her oxygen saturation levels were less than 90 percent. She was one of many COVID-19 patients referred to the Pavilion for Women, where we specialize in high-level care for high-risk and critically ill patients.

“I never realized my condition would get worse to the point where I would need to be airlifted to a different hospital for care,” Emma said. “My symptoms began with a sore throat and then I ran a 102.6 fever. I had night sweats, and shortly thereafter, I experienced the worst symptom of all – shortness of breath. It was a horrible feeling gasping for air. I was grateful to be at the Pavilion for Women where I got the best care.”

Our multidisciplinary team collaborated on Emma’s treatment plan for COVID-19 pneumonia while closely monitoring her pregnancy. Since Emma had trouble breathing on her own, she was placed on a ventilator for seven days. Along with sedation medications, Emma’s COVID-19 treatment regimen consisted of a combination of therapies, including remdesivir, an antiviral medication approved by the FDA for emergency use to treat the most severe cases of COVID-19, and corticosteroids (such as dexamethesone), which the World Health Organization considers the standard of care for treating patients with severe and critical COVID-19. During her first three days of hospitalization, Emma was given pulmonary vasodilators, which are a class of medication that dilate the blood vessels in the lungs to improve oxygenation and blood flow.

Corticosteroid therapy provides dual benefit for the mother and the unborn baby. For the mother, the steroids dampen the patient’s immune system from attacking the lungs. This allows the lungs to heal from the inflammation caused by COVID-19. When a baby is at risk of being born prematurely, giving steroids to the mother before delivery can help the unborn baby’s lungs develop more quickly and mature other organ systems as well. In Emma’s case, we prescribed a 10-day course of steroids which is recommended for patients requiring oxygenation and mechanical ventilation with COVID-19. The steroids were then passed on to the baby via placenta. As we were treating Emma for COVID-19, her respiratory condition was worsening and her oxygen levels were still low. To ensure the safety of mom and the baby, our team determined it was best to deliver Emma’s baby early.

On Oct. 18, 2020, our maternal fetal medicine team performed a primary cesarean delivery while Emma was still intubated. Baby Eleanor was born at 29 weeks and was cared for in our neonatal intensive care unit (NICU) for 70 days at the Pavilion for Women. After her daughter’s birth, Emma’s condition improved.

Before she was discharged, Emma underwent pulmonary physical therapy (PT). Diaphragmatic breathing was used to open Emma’s lower airways and facilitate clearing her lungs. Her thoracic spine was mobilized to improve alignment and joint range of motion, and decrease any movement restrictions. Arm exercises in reclined sitting and then upright sitting were incorporated with diaphragmatic breathing to allow for deeper breaths and improved chest expansion. Due to the effects of COVID-19 on her lungs, Emma’s oxygen saturation was maintained through each step and adequate breaks were given for her to recover. With great lung clearance, her PT was able to progress with mobility at a steady pace. Outside of her sessions, she practiced the diaphragmatic breathing and chest expansion exercises which helped expedite her recovery and hospital discharge.

“If it weren’t for the amazing team who took great care of me at the Pavilion for Women, I don’t think I would be here to share my COVID-19 survival story,” Emma said. “Throughout this ordeal, I was very concerned about my condition, but also the condition of my unborn baby. While I was not awake to see Eleanor’s delivery, I am so grateful to the team who delivered her and the incredible NICU nurses who took such great care of my daughter. Both of us are doing well. I am so thankful I can breathe on my own – It’s such an incredible feeling. Sometimes, it’s easy to take these simple things for granted.”

Click here to learn more about our maternal ICU at Texas Children’s Pavilion for Women and the level IV care we provide to our most critically ill patients, including those with high-risk pregnancies.